US20170238994A1 - Ablation Device with Guide Sleeves - Google Patents
Ablation Device with Guide Sleeves Download PDFInfo
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- US20170238994A1 US20170238994A1 US15/591,655 US201715591655A US2017238994A1 US 20170238994 A1 US20170238994 A1 US 20170238994A1 US 201715591655 A US201715591655 A US 201715591655A US 2017238994 A1 US2017238994 A1 US 2017238994A1
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61B2018/00613—Irreversible electroporation
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- A61B18/1206—Generators therefor
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Definitions
- Irreversible electroporation is a new tissue ablation technique in which very high energy electrical pulses are delivered to undesirable tissue to produce cell necrosis.
- IRE irreversible electroporation
- the only commercially available single probe bipolar device for an irreversible electroporation (IRE) procedure is capable of creating a maximum of 1.5 cm ablation.
- the user/physician needs to use two or more single probes to perform the ablation.
- the size of ablation/tumor will determine the number of probes (at times up to six) that are needed to be used to perform the procedure.
- These probes need to be closely aligned and tightly spaced to achieve optimal IRE ablation results. The need to place several probes and have them closely aligned can potentially complicate and lengthen the procedure time and consequently the operating room use time required.
- distal is consistently used in reference to the device or portion of the device farthest from the user and “proximal” refers to the end closest to the user of the device.
- FIG. 1 illustrates a medical treatment system including an energy delivery device with electrodes in a deployed position.
- FIG. 3 illustrates a functional block diagram of a user computer for managing treatment for a patient.
- FIGS. 4-6 are perspective views of the distal portion of the energy delivery device of FIG. 1 illustrating deployment of the electrodes at various angles of deployment relative to the longitudinal axis of the probe body.
- FIG. 9 is a perspective view illustrating the mating of the proximal portion of the introducer sheath of FIG. 8 with the distal portion of the handle of the energy delivery device of FIG. 1 .
- FIGS. 13-14 illustrate a perspective view of alternative embodiments of an energy delivery device having a plurality of first elongate electrode elements which longitudinally overlap with a plurality of second elongate electrode elements.
- resistance and impedance have the same meaning and are used interchangeably.
- the energy delivery device 1 is designed as a single stick device in which the sharp distal probe tip 30 of the device 1 pierces tissue so as to position the device 1 inside the tissue.
- the electrodes 7 - 17 are then deployed radially away from the probe portion 5 through the guide sleeves 22 .
- Each electrode is surrounded by an insulation layer 20 , but a distal portion of the electrode is exposed to enable electrical treatment.
- the amount of exposure of the distal portion of the electrode is in the range of about 0.5 cm to 1.5 cm.
- the energy delivery device 1 is coupled to an energy source (e.g., electrical pulse generator) 25 via a cable 27 or other attachment mechanisms known in the art.
- a user computer 40 is connected to the pulse generator 25 through a communication link 52 and controls the energy source to treat a patient.
- the cable 27 contains insulated wires that are coupled to the respective electrodes 7 - 17 .
- the energy source 25 can be capable of releasing energy for purposes of electroporation (including irreversible electroporation), radiofrequency, or other applications.
- This device can be utilized in applying direct current (DC) or alternating (AC) electrical signals that act on one or more cellular structures including but not limited to internal or external membranes, layers, bi-layers, mitochondria, the nucleus, cellular structures within the nucleus, ribosomes, DNA, RNA, reticulum, lysosomes, tubules, vacuoles, as well as application to structures such as proteins and lipids therein.
- DC direct current
- AC alternating
- FIG. 2 illustrates a functional block diagram of the pulse generator 25 according to one aspect of the device.
- a USB (universal serial bus) connection 52 carries instructions from a user computer 40 to a controller 56 .
- the controller 56 can be a computer similar to the computer 40 as shown in FIG. 1 .
- the controller 56 can include a processor, ASIC (application-specific integrated circuit), microcontroller or wired logic.
- the controller 56 sends the instructions from the user computer 40 to a pulse generation circuit 58 .
- the pulse generation circuit 58 generates the pulses and transmits them to the electrodes 7 - 17 and 30 through the cable 27 . As shown, the pulses are applied one pair of electrodes at a time, and then switched to another pair.
- a sensor 60 can sense the resistance (e.g., current and/or voltage) between each pair of the electrodes in real time and communicate such information to the controller 56 , which in turn, communicates the information to the computer 40 .
- the resistance e.g., current and/or voltage
- the user interacts with the treatment control module 54 through input devices 43 (e.g., keyboard, mouse, touch screen, trackball and the like) and a display device 41 .
- input devices 43 e.g., keyboard, mouse, touch screen, trackball and the like
- display device 41 Any of the software program modules in the program storage 48 and data from the data storage 50 can be transferred to the memory 44 as needed and is executed by the CPU 46 .
- FIG. 4 is a perspective view of the distal portion of the energy delivery device of FIG. 1 illustrating deployment of the electrodes 7 - 17 at approximately a 45 degree angle ( ⁇ ) of deployment relative to the longitudinal axis A of the probe body 5 .
- FIG. 5 is a perspective view of the distal portion of the energy delivery device of FIG. 1 illustrating deployment of the electrodes 7 - 17 at approximately a 90 degree angle ( ⁇ ) of deployment relative to the longitudinal axis A of the probe body 5 .
- FIG. 4 is a perspective view of the distal portion of the energy delivery device of FIG. 1 illustrating deployment of the electrodes 7 - 17 at approximately a 45 degree angle ( ⁇ ) of deployment relative to the longitudinal axis A of the probe body 5 .
- FIG. 5 is a perspective view of the distal portion of the energy delivery device of FIG. 1 illustrating deployment of the electrodes 7 - 17 at approximately a 90 degree angle ( ⁇ ) of deployment relative to the longitudinal axis A of the probe body 5 .
- FIG. 6 is a perspective view of the distal portion of the energy delivery device of FIG. 1 illustrating deployment of the electrodes 7 - 17 at approximately a 180 degree angle ( ⁇ ) of deployment relative to the longitudinal axis A of the probe body 5 .
- the extent of deployment of the guide sleeves 22 can be individually controlled for producing a combination of deployment angles for the collection of electrodes.
- the angle of deployment relative to the longitudinal axis can be any angle in the range of about zero to about 180 degrees from the longitudinal axis A of the probe body 5 .
- each guide sleeve 22 is pre-curved and includes a proximal curved portion and a distal straight portion. This configuration will allow for the electrodes to exit the distal portion of the respective guide sleeve and protrude the tissue in a straight and parallel form which is an important requirement for IRE procedure to ensure optimal results.
- the guide sleeve 22 has a semi-circular pre-curved shape.
- the guide sleeves are provided with an electrically active area at its distal portion, then it is possible for such active areas to be in electrical contact with the electrode elements 7 - 17 when the electrode elements are partially deployed such that the insulation 20 stays well inside the guide sleeves 22 . In that case, both the electrically active areas of the guide sleeves 22 and the exposed electrode elements 7 - 17 which are in electrical contact act as electrodes.
- FIG. 7 is a cross-sectional perspective view of the area of the electrode surrounded by a guide sleeve from FIG. 5 along line 7 - 7 .
- the electrode 7 is surrounded by a layer of insulation 20 which is non-conductive, such as polyimide.
- Each guide sleeve 22 surrounds the electrode and has an inner diameter that is larger than the outer diameter of the layer of insulation 20 so that the electrodes can be deployed through each guide sleeve 22 as explained above.
- FIG. 9 is a perspective view illustrating the mating of the proximal portion of the introducer sheath 70 of FIG. 8 with the distal portion of the handle of the energy delivery device of FIG. 1 .
- the swivel locking cap 2 (see also FIG. 1 ) is connected to the main handle 3 of the energy deliver device and is adapted to mate with the locking member 71 of the introducer sheath 70 .
- the swivel locking cap 2 includes a threaded inner surface that engages with corresponding threads on the outer surface of the locking member 71 .
- the swivel locking cap 2 can include ridges in its outer surface to assist the user in twisting the locking cap for locking/unlocking.
- the proximal electrical connector 73 of the introducer sheath 70 is connected to an electrical connection 32 located on the probe body for passing electrical treatment energy. As illustrated in the example, this connection can be a frictional engagement between the inner surface of the proximal electrical connector 73 and the outer surface of the electrical connection 32 .
- FIGS. 10-12 illustrate side views of an alternative embodiment of an energy delivery device with a retractable outer sleeve 33 .
- a probe tip 30 is attached to a shaft 34 that is disposed inside the probe body 5 .
- the probe tip 30 has a sharp distal end adapted to pierce the tissue.
- the probe tip 30 has a proximal portion that is adapted to fit within the outer sleeve 33 .
- the probe tip 30 further includes a tapered portion 36 that frictionally engages with the inside surface of the outer sleeve 33 to lock the proximal portion of the probe tip 30 within the distal portion of the probe body 5 in a “closed” position, as shown in FIG. 10 .
- the probe tip 30 When the probe tip 30 is in the “closed” position, it provides structural strength (lateral and longitudinal strength) during insertion of the probe body 5 into the tissue.
- the proximal portion of the probe tip 30 in contact with the distal portion of the probe body 5 in the “closed” position can be electrically insulated.
- the probe body 5 can be further coated with an insulation layer of polyester.
- the outer sleeve 33 of the probe body 5 can be mechanically connected to a third main slide tab (not shown) on the proximal handle 23 (see FIG. 1 ). After the probe body 5 is inserted into the tissue, the outer sleeve 33 of the probe body 5 is retracted into an “open” position via the third main slide tab, as shown in FIG. 11 , in which a distal portion of the probe body 5 is longitudinally spaced from the proximal portion of the probe tip 30 .
- the tapered portion 36 is illustrated as having both a tapered leading edge and a tapered trailing edge to allow this portion of the outer surface of the probe tip 30 to become disengaged from the inside surface of the outer sleeve 33 , when desired by the physician.
- a distal portion of the probe tip 30 can include an electrode area adapted to deliver the electrical treatment energy to the tissue.
- the distal portion of the probe body 5 can include an electrode area 19 adapted to deliver the electrical treatment energy to the tissue.
- FIGS. 13-14 illustrate a perspective view of alternative embodiments of an energy delivery device having a plurality of first elongate electrode elements which longitudinally overlap with a plurality of second elongate electrode elements.
- FIG. 13 shows an alternative embodiment wherein the energy delivery device 1 includes a plurality of second elongate electrode elements 90 positioned proximally of the plurality of first elongate electrode elements 80 (as described as elements 7 - 17 with reference to FIG. 1 ) and adapted to be deployed radially away from the probe body 5 and into the tissue such that the deployed first electrode elements 80 longitudinally overlap with the deployed second electrode elements 90 .
- the electrode elements 80 deploy in a convex manner while the second electrode elements 90 deploy in a concave manner.
- This embodiment can make it possible to create a larger area of ablation.
- the longitudinal spacing between the first and second electrode elements can vary by design based on the treatment requirements.
- FIG. 14 shows an alternative embodiment wherein the energy delivery device 1 includes a plurality of second elongate electrode elements 90 positioned proximally of the plurality of first elongate electrode elements 80 (as described with reference to FIG. 1 ) and adapted to be deployed distally and radially away from the probe body 5 and into the tissue such that the deployed first electrode elements 80 longitudinally overlap with the deployed second electrode elements 90 .
- both sets of electrode elements deploy in a convex manner.
- This embodiment can make it possible to create a larger area of ablation.
- a two tier design is achieved wherein the first elongate electrode elements 80 create a larger tier and the second elongate electrode elements 90 create a smaller tier “nested” within the larger tier.
- the longitudinal spacing between the first and second electrode elements and the relative sizes of the tiers can vary by design based on the treatment requirements.
- a method of treating a patient using the energy delivery device 1 of the present invention will now be described. Prior to inserting the device into the tissue, certain procedures are performed. Specifically, the physician identifies a target tissue zone to be ablated in a patient and selects an appropriate multi-electrode probe for the treatment (e.g., probe with 6 electrodes).
- an appropriate multi-electrode probe for the treatment e.g., probe with 6 electrodes.
- the physician deploys the plurality of guide sleeves 22 positioned inside the probe body 5 radially away from the probe body 5 and into the tissue.
- the guide sleeves 22 can be pre-curved and the amount of deployment of each guide sleeve can be selected to establish the angle of deployment for the elongate electrode elements relative to the longitudinal axis of the probe body 5 (see FIGS. 4-6 ).
- the physician deploys the plurality of elongate electrode elements 7 - 17 through the deployed guide sleeves 22 using the deployed guide sleeves 22 as a guide.
- electrical treatment is delivered to the tissue.
- the step of inserting the probe body includes: inserting the probe body with the probe tip 30 in the “closed” position; and moving the probe tip 30 to the “open” position for deployment of the plurality of elongate electrode elements.
- the apparatus and method disclosed herein can be used in laparoscopic, percutaneous, natural orifice procedures (NOTES), as well as open surgical procedures as well as when the target tissue either actually is one of the following tissues or is within the following tissues: digestive, skeletal, muscular, nervous, endocrine, circulatory, reproductive, integumentary, lymphatic, urinary, and soft tissue.
- the method can be used to target tissue of or within a vessel, a liver, or lung tissue.
- the method can also be used singly or in combination in tissues that are in the pancreas, prostate, uterus and brain.
- the method can also be used to target singly or in combination tissues that are benign, malignant, cancerous, neoplastic, preneoplastic, or tumorous.
- the apparatus and method disclosed herein can be used with various treatment modalities including radiofrequency, reversible electroporation, irreversible electroporation, and supraporation.
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Abstract
Description
- This application claims priority under 35 U.S.C. 119(e) to U.S. Provisional Application No. 61/304,854, filed Feb. 16, 2010, and U.S. Provisional Application No. 61/392,967, filed Oct. 14, 2010, each of which is incorporated herein by reference.
- The present invention relates to medical devices. More specifically, the present invention relates to a multi-electrode energy delivery device for delivering electrical energy to treat a patient.
- Irreversible electroporation (IRE) is a new tissue ablation technique in which very high energy electrical pulses are delivered to undesirable tissue to produce cell necrosis. Currently the only commercially available single probe bipolar device for an irreversible electroporation (IRE) procedure is capable of creating a maximum of 1.5 cm ablation. In cases where there is a need for a larger ablation, the user/physician needs to use two or more single probes to perform the ablation. Generally, the size of ablation/tumor will determine the number of probes (at times up to six) that are needed to be used to perform the procedure. These probes need to be closely aligned and tightly spaced to achieve optimal IRE ablation results. The need to place several probes and have them closely aligned can potentially complicate and lengthen the procedure time and consequently the operating room use time required.
- Various configurations of antennae as well as electrode probes for ablation of undesired tissue in a patient are known in the art. The term “antennae” and “tines” are known in the art as referring to aspects of radiofrequency (RF) devices and the term “electrode” is known in the art as referring to electrical devices in the context of supraporation (electropurturbation) devices, electroporation (RE) devices and especially in irreversible electroporation (IRE) devices. For convenience and efficiency, in this application, the terms “antennae”, “tine” and “electrode” are used interchangeably whether in single or plural form to refer to parts that deliver electrical energy in electrical ablation devices including RF, supraporation, RE and IRE devices.
- A detailed explanation of IRE can be found, for example, in U.S. Patent Application Publication No. 2006/0293731, entitled “Methods and systems for treating tumors using electroporation”, application Ser. No. 11/165,961 filed on Jun. 24, 2005, which is hereby incorporated by reference. In IRE, electrical pulses in the range of microseconds to milliseconds can be applied to a target tissue zone to produce defects in the cell membrane that are nanoscale in size. The defects in the cell membrane lead to a disruption of homeostasis and eventually cause the cells to die. IRE devices can be designed to be non-thermal and the IRE pulses do not destroy connective and scaffolding structure in the target zone such as nerves and blood vessels.
- The IRE pulses are applied using electrical probes, which can be monopolar, bipolar or multi-electrode. The probe designs are similar to the RF probes and accordingly are subject to some of the same problems involving energy distribution along the electrodes.
- A single bipolar probe or multi-electrode probe can be used to ablate diseased or unwanted tissue. The positive and negative electrodes are located on a single probe and the tissue is ablated as energy flows from the positive to the negative electrode. Although the bipolar design provides efficient energy deposition in the tissue, the maximum ablation volume is limited and the resulting cylindrical shape of ablation often does not correspond with the targeted tumor shape.
- Probes having electrode arrays with an umbrella-like profile achieve larger, more spherical ablations with a single puncture. In this type of probe, two or more outwardly curving tines (electrodes) are placed within the tumor, at predetermined positions, and electrical energy flows between one or more pairs of active tines or electrodes in the array. However, while the array of electrodes in this type of probe is being deployed, the electrodes may lack sufficient strength to adequately pierce through the tissue or may deploy at a wrong angle and can therefore deviate from their intended trajectory. For example, the electrodes may lack sufficient strength to pierce through certain types of more rigid “soft” tissues, such as such as tissues found in the liver, kidneys, lungs, etc. If the electrodes deviate from their intended path and are not ultimately positioned in their predetermined intended locations, treatment of the tissue may not be successful and/or other risks and dangers to the patient may be presented.
- The current device and method provides an energy delivery device for treating a patient. The energy delivery device includes a probe body; a plurality of guide sleeves positioned inside the probe body and adapted to be deployed radially away from the probe body and into tissue of the patient; and a plurality of elongate electrode elements each adapted to receive electrical treatment energy from an energy source and adapted to be deployed into the tissue through a corresponding deployed guide sleeve.
- A more complete understanding of the present device and method can be derived by referring to the detailed description when considered in connection with the following illustrative figures. In the figures, like reference numbers refer to like elements or acts throughout the figures. Throughout the specification, the term “distal” is consistently used in reference to the device or portion of the device farthest from the user and “proximal” refers to the end closest to the user of the device.
-
FIG. 1 illustrates a medical treatment system including an energy delivery device with electrodes in a deployed position. -
FIG. 2 illustrates a functional block diagram of a pulse generator. -
FIG. 3 illustrates a functional block diagram of a user computer for managing treatment for a patient. -
FIGS. 4-6 are perspective views of the distal portion of the energy delivery device ofFIG. 1 illustrating deployment of the electrodes at various angles of deployment relative to the longitudinal axis of the probe body. -
FIG. 7 is a cross-sectional perspective view of the area of the electrode surrounded by a guide sleeve fromFIG. 5 along line 7-7. -
FIG. 8 is an exploded assembly view of an introducer sheath and a corresponding stylet adapted for insertion through the introducer sheath. -
FIG. 9 is a perspective view illustrating the mating of the proximal portion of the introducer sheath ofFIG. 8 with the distal portion of the handle of the energy delivery device ofFIG. 1 . -
FIGS. 10-12 illustrate side views of an alternative embodiment of an energy delivery device with a retractable outer sleeve. -
FIGS. 13-14 illustrate a perspective view of alternative embodiments of an energy delivery device having a plurality of first elongate electrode elements which longitudinally overlap with a plurality of second elongate electrode elements. - Elements and acts in the figures are illustrated for simplicity and have not necessarily been rendered according to any particular sequence or embodiment.
- In the following description, and for the purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of the various aspects of the current device and method. It will be understood, however, by those skilled in the relevant arts, that the present device and method can be practiced without these specific details. In other instances, known structures and devices are shown or discussed more generally in order to avoid obscuring the present device and method. In many cases, a description of the operation is sufficient to enable one to implement the various forms of the device and method. It should be noted that there are many different and alternative configurations, devices and technologies to which the disclosed device and method can be applied. The full scope of the device and method is not limited to the examples that are described below.
- For purpose of this application, the term resistance and impedance have the same meaning and are used interchangeably.
-
FIG. 1 illustrates a medical treatment system including anenergy delivery device 1 with electrodes in a deployed position. Theenergy delivery device 1 is designed for tissue treatment using electrical treatment signals (i.e., electrical energy such as electrical pulses or alternating current for general or specific purposes such as for electroporative or radiofrequency purposes). Theenergy delivery device 1 includes amain handle 3, aswivel locking cap 2 attached to the main handle, anelongated probe body 5, anelectrode area 19 on the probe body, and asharp probe tip 30 at the distal end of theprobe body 5 for piercing tissue. The probe body is surrounded byinsulation material 21, such as any strong, non-conducting polymer (i.e. polyimide). A plurality ofguide sleeves 22 are positioned inside theprobe body 5 and are adapted to be deployed radially away from theprobe body 5 and into tissue of a patient (not shown). - A plurality of curved antenna or
electrodes guide sleeve 22. The device is illustrated inFIG. 1 as including six electrodes. However, the device can have any number of electrodes. The number of electrodes may correspond to the volume of tissue that is to be treated. In one aspect, a distal portion of theprobe body 5 includes an electrode area adapted to deliver electrical treatment energy to the tissue. For example, a portion of thesharp probe tip 30 can include an electrode area. The electrodes 7-17 and the electrode area of thesharp probe tip 30 can be made from a conducting material, such as stainless steel or MRI-safe metal, such as INCONEL™ (registered trademark of Special Metals Corporation which refers to a family of austenitic nickel-chromium-based super alloys). - The
energy delivery device 1 is designed as a single stick device in which the sharpdistal probe tip 30 of thedevice 1 pierces tissue so as to position thedevice 1 inside the tissue. The electrodes 7-17 are then deployed radially away from theprobe portion 5 through theguide sleeves 22. Each electrode is surrounded by aninsulation layer 20, but a distal portion of the electrode is exposed to enable electrical treatment. In one embodiment, the amount of exposure of the distal portion of the electrode is in the range of about 0.5 cm to 1.5 cm. - A first
main slide tab 24 on theproximal handle 23 is adapted for a longitudinal sliding movement for controlling the deployment and retraction of the electrodes 7-17 from theelongated probe body 5 and through theguide sleeves 22. In the embodiment shown, the firstmain slide tab 24 has been fully advanced so as to show the electrodes in their fully deployed position. Theenergy delivery device 1 includes a deployment mechanism (inside the handle 23) configured to independently control the extent (length) of the deployment of each electrode from theprobe 5 usingelectrode slide tabs 26. Eachslide tab 26 controls a corresponding electrode movement independently of other electrodes. As shown inFIG. 1 , there are sixslide tabs 26 corresponding to the six electrodes 7-17. - The
guide sleeves 22 are deployed radially away from theprobe body 5 to guide the deployment of the electrodes as will be discussed in more detail later herein. A secondmain slide tab 29 is adapted for a longitudinal sliding movement for controlling the deployment and retraction of all guidesleeves 20 radially away from theprobe body 5 at the same time. Theenergy delivery device 1 includes a deployment mechanism (inside the handle 23) configured to independently control the extent (length) of the deployment of eachguide sleeve 22 from theprobe body 5 using guidesleeve slide tabs 28. Eachslide tab 28 controls a corresponding movement of aguide sleeve 22. As shown inFIG. 1 , there are six guidesleeve slide tabs 28 corresponding to the sixguide sleeves 22. - The
energy delivery device 1 is designed to apply IRE pulses to treat a patient. For example, thedevice 1 is designed to generate n sets of m pulses per set with each pulse having a duration of 1 microsecond to 1 millisecond, where n and m=2-20 and the pulse voltage being in the range of 400 volts/cm and 2500 volts/cm. - As shown, the
energy delivery device 1 is configured to apply a plurality of pulse sets with each pulse having a pulse duration of 50-150 microseconds and the voltage being 1000 volts/cm to 3000 volts/cm depending on the tissue type being treated. This is more fully described in applicant's application entitled “System and Method for Interactively Planning and Controlling a Treatment of a Patient with a Medical Treatment Device”, Ser. No. 12/751,854, filed Mar. 31, 2010, which is incorporated herein in its entirety by reference. Although the present invention is described with reference to IRE pulses, persons of ordinary skill in the art will appreciate that the invention can be applied to any ablation treatment using electrical pulses such as supraporation and radio frequency techniques. - The
energy delivery device 1 is coupled to an energy source (e.g., electrical pulse generator) 25 via acable 27 or other attachment mechanisms known in the art. Auser computer 40 is connected to thepulse generator 25 through acommunication link 52 and controls the energy source to treat a patient. Thecable 27 contains insulated wires that are coupled to the respective electrodes 7-17. Theenergy source 25 can be capable of releasing energy for purposes of electroporation (including irreversible electroporation), radiofrequency, or other applications. This device can be utilized in applying direct current (DC) or alternating (AC) electrical signals that act on one or more cellular structures including but not limited to internal or external membranes, layers, bi-layers, mitochondria, the nucleus, cellular structures within the nucleus, ribosomes, DNA, RNA, reticulum, lysosomes, tubules, vacuoles, as well as application to structures such as proteins and lipids therein. -
FIG. 2 illustrates a functional block diagram of thepulse generator 25 according to one aspect of the device. A USB (universal serial bus)connection 52 carries instructions from auser computer 40 to acontroller 56. Thecontroller 56 can be a computer similar to thecomputer 40 as shown inFIG. 1 . Thecontroller 56 can include a processor, ASIC (application-specific integrated circuit), microcontroller or wired logic. Thecontroller 56 sends the instructions from theuser computer 40 to apulse generation circuit 58. Thepulse generation circuit 58 generates the pulses and transmits them to the electrodes 7-17 and 30 through thecable 27. As shown, the pulses are applied one pair of electrodes at a time, and then switched to another pair. A switchingcircuit 62 is coupled to thecontroller 56 and switches the electrode pairs based on the instructions received from thecomputer 40 through the controller. For example, the switching pattern of the electrode pairs can be 30-7, 30-9, 30-11, 30-13, 30-15, and 30-17. - A
sensor 60 can sense the resistance (e.g., current and/or voltage) between each pair of the electrodes in real time and communicate such information to thecontroller 56, which in turn, communicates the information to thecomputer 40. - Referring now to
FIG. 3 , theuser computer 40 of the present device manages treatment for a patient. Thecomputer 40 is connected to thecommunication link 52 through an I/O interface 42 such as a USB (universal serial bus) interface, which receives information from and sends information over thecommunication link 52 to thepulse generator 25. Thecomputer 40 includesmemory storage 44 such as RAM, processor (CPU) 46,program storage 48 such as ROM or EEPROM, anddata storage 50 such as a hard disk, all commonly connected to each other through abus 53. Theprogram storage 48 stores, among others, atreatment control module 54 which includes a user interface module that interacts with the user in planning for, executing and reviewing the result of a treatment. The user interacts with thetreatment control module 54 through input devices 43 (e.g., keyboard, mouse, touch screen, trackball and the like) and adisplay device 41. Any of the software program modules in theprogram storage 48 and data from thedata storage 50 can be transferred to thememory 44 as needed and is executed by theCPU 46. - In one aspect, the
computer 40 is built into thevoltage generator 25. In another embodiment, thecomputer 40 is a separate unit which is connected to the voltage generator through the communications link 52. In another aspect, thecommunication link 52 is a USB link. - As shown in
FIGS. 4-6 , the extent ofguide sleeve 22 deployment determines the angle of deployment for the corresponding elongate electrode element 7-17 relative to the longitudinal axis A of theprobe body 5.FIG. 4 is a perspective view of the distal portion of the energy delivery device ofFIG. 1 illustrating deployment of the electrodes 7-17 at approximately a 45 degree angle (Θ) of deployment relative to the longitudinal axis A of theprobe body 5.FIG. 5 is a perspective view of the distal portion of the energy delivery device ofFIG. 1 illustrating deployment of the electrodes 7-17 at approximately a 90 degree angle (Θ) of deployment relative to the longitudinal axis A of theprobe body 5.FIG. 6 is a perspective view of the distal portion of the energy delivery device ofFIG. 1 illustrating deployment of the electrodes 7-17 at approximately a 180 degree angle (Θ) of deployment relative to the longitudinal axis A of theprobe body 5. As described above, in one embodiment, the extent of deployment of theguide sleeves 22 can be individually controlled for producing a combination of deployment angles for the collection of electrodes. The angle of deployment relative to the longitudinal axis can be any angle in the range of about zero to about 180 degrees from the longitudinal axis A of theprobe body 5. - Advantageously, the
guide sleeves 22 also ensure that the electrodes are deployed at a predetermined circumferential angle and are uniformly spaced relative to each other. For example, with a six electrode element configuration as shown inFIG. 4 , theguide sleeves 22 ensure that the circumferential angle between any two electrode elements is 60 degrees. - The
guide sleeves 22 are formed from a material that preferably has a higher strength than the electrodes to thereby pierce tissue and provide a strong pathway for the electrodes to follow during deployment. In one example, theguide sleeves 22 are formed from nickel titanium. In one embodiment, eachguide sleeve 22 includes an electrode area adapted to deliver the electrical treatment energy to the tissue. - In one embodiment each
guide sleeve 22 is pre-curved and includes a proximal curved portion and a distal straight portion. This configuration will allow for the electrodes to exit the distal portion of the respective guide sleeve and protrude the tissue in a straight and parallel form which is an important requirement for IRE procedure to ensure optimal results. In one embodiment theguide sleeve 22 has a semi-circular pre-curved shape. - In one embodiment, as shown in
FIGS. 4-6 , an area proximal to the location where theguide sleeves 22 exit theprobe body 5 includes anelectrode area 19 adapted to deliver the electrical treatment energy to the tissue. This allows another potential pathway for delivering the electrical treatment energy. Thus, ablation electrical pulses can be applied between any two of the following electrode elements or areas:probe tip 30,electrode area 19,electrode elements guide sleeves 22 to provide maximum flexibility in matching the ablation zone to the target zone. - If the guide sleeves are provided with an electrically active area at its distal portion, then it is possible for such active areas to be in electrical contact with the electrode elements 7-17 when the electrode elements are partially deployed such that the
insulation 20 stays well inside theguide sleeves 22. In that case, both the electrically active areas of theguide sleeves 22 and the exposed electrode elements 7-17 which are in electrical contact act as electrodes. - In another embodiment, a portion of each
guide sleeve 22 includes an electrode area (not shown) adapted to deliver electrical treatment energy to the tissue. This allows yet another potential pathway for delivering the electrical treatment energy. -
FIG. 7 is a cross-sectional perspective view of the area of the electrode surrounded by a guide sleeve fromFIG. 5 along line 7-7. Theelectrode 7 is surrounded by a layer ofinsulation 20 which is non-conductive, such as polyimide. Eachguide sleeve 22 surrounds the electrode and has an inner diameter that is larger than the outer diameter of the layer ofinsulation 20 so that the electrodes can be deployed through eachguide sleeve 22 as explained above. -
FIG. 8 is an exploded assembly view of anintroducer sheath 70 and a correspondingstylet 60 adapted for insertion through theintroducer sheath 70. Theintroducer sheath 70 includes anelectrode area 72 at its distal end, which is adapted to deliver the electrical treatment energy to the tissue. Theintroducer sheath 70 includes a proximal electrical connector 73 (i.e. “banana plug” as known in the art) coupled to theelectrode area 72 and connectable to an electrical connection located on the probe body (seeFIG. 9 ). Thestylet 60 is adapted to be inserted into theintroducer sheath 70 and locked thereto by the corresponding lockingmembers stylet 60 includes a sharp distal tip adapted for piercing tissue during insertion of the introducer sheath/stylet assembly. - After the introducer sheath/stylet assembly has been positioned at the treatment site by the physician/user, the corresponding locking
members stylet 60 is removed and the probe body of the treatment device ofFIG. 1 is inserted through the introducer sheath.FIG. 9 is a perspective view illustrating the mating of the proximal portion of theintroducer sheath 70 ofFIG. 8 with the distal portion of the handle of the energy delivery device ofFIG. 1 . The swivel locking cap 2 (see alsoFIG. 1 ) is connected to themain handle 3 of the energy deliver device and is adapted to mate with the lockingmember 71 of theintroducer sheath 70. In one embodiment, theswivel locking cap 2 includes a threaded inner surface that engages with corresponding threads on the outer surface of the lockingmember 71. Theswivel locking cap 2 can include ridges in its outer surface to assist the user in twisting the locking cap for locking/unlocking. In a locked configuration, the proximalelectrical connector 73 of theintroducer sheath 70 is connected to anelectrical connection 32 located on the probe body for passing electrical treatment energy. As illustrated in the example, this connection can be a frictional engagement between the inner surface of the proximalelectrical connector 73 and the outer surface of theelectrical connection 32. -
FIGS. 10-12 illustrate side views of an alternative embodiment of an energy delivery device with a retractableouter sleeve 33. Aprobe tip 30 is attached to ashaft 34 that is disposed inside theprobe body 5. Theprobe tip 30 has a sharp distal end adapted to pierce the tissue. Theprobe tip 30 has a proximal portion that is adapted to fit within theouter sleeve 33. Theprobe tip 30 further includes a taperedportion 36 that frictionally engages with the inside surface of theouter sleeve 33 to lock the proximal portion of theprobe tip 30 within the distal portion of theprobe body 5 in a “closed” position, as shown inFIG. 10 . When theprobe tip 30 is in the “closed” position, it provides structural strength (lateral and longitudinal strength) during insertion of theprobe body 5 into the tissue. The proximal portion of theprobe tip 30 in contact with the distal portion of theprobe body 5 in the “closed” position can be electrically insulated. Theprobe body 5 can be further coated with an insulation layer of polyester. - The
outer sleeve 33 of theprobe body 5 can be mechanically connected to a third main slide tab (not shown) on the proximal handle 23 (seeFIG. 1 ). After theprobe body 5 is inserted into the tissue, theouter sleeve 33 of theprobe body 5 is retracted into an “open” position via the third main slide tab, as shown inFIG. 11 , in which a distal portion of theprobe body 5 is longitudinally spaced from the proximal portion of theprobe tip 30. The taperedportion 36 is illustrated as having both a tapered leading edge and a tapered trailing edge to allow this portion of the outer surface of theprobe tip 30 to become disengaged from the inside surface of theouter sleeve 33, when desired by the physician. In the “open” position, theguide sleeves 22 and/or electrodes 9-17 can be deployed radially away from theprobe body 5 and into the tissue, as explained above and as shown inFIG. 12 . As explained above, the extent of guide sleeve deployment determines the angle of deployment for the corresponding elongate electrode element relative to the longitudinal axis of the probe body. In one aspect, a distal portion of theprobe tip 30 can include an electrode area adapted to deliver the electrical treatment energy to the tissue. In another aspect, the distal portion of theprobe body 5 can include anelectrode area 19 adapted to deliver the electrical treatment energy to the tissue. -
FIGS. 13-14 illustrate a perspective view of alternative embodiments of an energy delivery device having a plurality of first elongate electrode elements which longitudinally overlap with a plurality of second elongate electrode elements. -
FIG. 13 shows an alternative embodiment wherein theenergy delivery device 1 includes a plurality of secondelongate electrode elements 90 positioned proximally of the plurality of first elongate electrode elements 80 (as described as elements 7-17 with reference toFIG. 1 ) and adapted to be deployed radially away from theprobe body 5 and into the tissue such that the deployedfirst electrode elements 80 longitudinally overlap with the deployedsecond electrode elements 90. In the embodiment shown inFIG. 13 , viewing theprobe body 5 from theprobe tip 30, theelectrode elements 80 deploy in a convex manner while thesecond electrode elements 90 deploy in a concave manner. This embodiment can make it possible to create a larger area of ablation. The longitudinal spacing between the first and second electrode elements can vary by design based on the treatment requirements. -
FIG. 14 shows an alternative embodiment wherein theenergy delivery device 1 includes a plurality of secondelongate electrode elements 90 positioned proximally of the plurality of first elongate electrode elements 80 (as described with reference toFIG. 1 ) and adapted to be deployed distally and radially away from theprobe body 5 and into the tissue such that the deployedfirst electrode elements 80 longitudinally overlap with the deployedsecond electrode elements 90. In this embodiment, both sets of electrode elements deploy in a convex manner. This embodiment can make it possible to create a larger area of ablation. In one aspect, a two tier design is achieved wherein the firstelongate electrode elements 80 create a larger tier and the secondelongate electrode elements 90 create a smaller tier “nested” within the larger tier. The longitudinal spacing between the first and second electrode elements and the relative sizes of the tiers can vary by design based on the treatment requirements. - A method of treating a patient using the
energy delivery device 1 of the present invention will now be described. Prior to inserting the device into the tissue, certain procedures are performed. Specifically, the physician identifies a target tissue zone to be ablated in a patient and selects an appropriate multi-electrode probe for the treatment (e.g., probe with 6 electrodes). - An introducer sheath 70 (see
FIG. 8 ) can be inserted into the tissue as an optional first step, wherein theintroducer sheath 70 can include anelectrode area 72 adapted to deliver electrical treatment energy to the tissue. Then, the selectedprobe body 5 is inserted through theintroducer sheath 70, if used, and into the identified tissue zone by piercing the tissue with the sharp end of theprobe body 5. If theintroducer sheath 70 is used, then the proximal electrical connector 73 (seeFIG. 9 ) is coupled to theelectrode area 72 by connecting the proximalelectrical connector 73 to anelectrical connection 32 located on the probe body. - Once the
probe body 5 is inserted, the physician deploys the plurality ofguide sleeves 22 positioned inside theprobe body 5 radially away from theprobe body 5 and into the tissue. As described above, theguide sleeves 22 can be pre-curved and the amount of deployment of each guide sleeve can be selected to establish the angle of deployment for the elongate electrode elements relative to the longitudinal axis of the probe body 5 (seeFIGS. 4-6 ). Next, the physician deploys the plurality of elongate electrode elements 7-17 through the deployedguide sleeves 22 using the deployedguide sleeves 22 as a guide. Next, electrical treatment is delivered to the tissue. - In an alternative embodiment, if the treatment method includes the device described in
FIGS. 10-12 above, then the step of inserting the probe body includes: inserting the probe body with theprobe tip 30 in the “closed” position; and moving theprobe tip 30 to the “open” position for deployment of the plurality of elongate electrode elements. - The apparatus and method disclosed herein can be used in laparoscopic, percutaneous, natural orifice procedures (NOTES), as well as open surgical procedures as well as when the target tissue either actually is one of the following tissues or is within the following tissues: digestive, skeletal, muscular, nervous, endocrine, circulatory, reproductive, integumentary, lymphatic, urinary, and soft tissue. The method can be used to target tissue of or within a vessel, a liver, or lung tissue. The method can also be used singly or in combination in tissues that are in the pancreas, prostate, uterus and brain. The method can also be used to target singly or in combination tissues that are benign, malignant, cancerous, neoplastic, preneoplastic, or tumorous.
- The apparatus and method disclosed herein can be used with various treatment modalities including radiofrequency, reversible electroporation, irreversible electroporation, and supraporation.
- The above disclosure is intended to be illustrative and not exhaustive. This description will suggest many modifications, variations, and alternatives may be made by ordinary skill in this art without departing from the scope of the device and method. Those familiar with the art may recognize other equivalents to the specific embodiments described herein. Accordingly, the scope of the device and method described herein is not limited to the foregoing specification.
Claims (39)
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US20110202053A1 (en) | 2011-08-18 |
WO2011103096A2 (en) | 2011-08-25 |
WO2011103096A3 (en) | 2011-12-08 |
US9675406B2 (en) | 2017-06-13 |
US10751116B2 (en) | 2020-08-25 |
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